Neutropenic sepsis

Topotecan Neutropenic fever, neutropenic sepsis, anemia, thrombocytopenia, nausea, fatigue, vomiting, stomatitis, anorexia, diarrhea, fever Mild (days 1-5)... 

Suramin was not effective in one phase II study in advanced renal cell carcinoma, in which it was given in a fixed dose plus hydrocortisone to 22 patients (19 men, three women, aged 30-74 years) (11). Three patients had grade 4 toxicity (hypersensitivity, urethral obstruction, hypotension, and neutropenic sepsis). Eleven developed grade 3 toxicity, mainly abdominal pain, anemia, diarrhea, erythema, dyspnea, fatigue, and fever. 

An 83-year-old man who had been taking multiple medications including simvastatin 40 mg daily for 2 years was given fluconazole 400 mg daily as part of a prophylactic regimen against chemotherapy-induced neutropenic sepsis. After one week he developed generalised muscle weakness and was found to have brown urine and an elevated serum creatine kinase. His medication was stopped, and he was treated with hydration and diuretics, after which his symptoms resolved. ... 

Booth K, Parissis H. Teicoplanin-induced neutropenic sepsis rtiimickmg endocarditis. Asian Cardiovasc Thorac Ann2012 20(4) 460-2. Nannini EC, Corey GR, Stryjewski ME. Telavancin for the treatment of hospital-acquired pneumonia findings from the ATTAIN studies. Expert Rev Anti Infect Ther 2012 10(8) 847-54. 

Infection is a primary cause of death in acute leukemia patients. The majority of chemotherapy used to treat ALL and AML can cause severe myelosupression, placing the patient at risk for sepsis from otherwise normal bacteria. It is important to recognize that symptoms and signs of infection maybe absent in a severely immunosuppressed or neutropenic patient. Fever (greater than 38.3°C, 100.9°F) in a neutropenic patient is a medical emergency. Following chemotherapy, the period of neutropenia usually reaches its nadir approximately 14 days after the... 

Suspected systemic mycotic infection leading to sepsis in neutropenic and critically ill patients should be empirically treated with parenteral amphotericin B or caspofungin, especially if the patient is clinically unstable. 

Amphotericin B remains the drug of choice in the treatment of invasive aspergillosis, locally invasive mucormycosis, and many disseminated fungal infections occurring in immunocompromised hosts (the patient population most at risk for serious fungal infections). For example, the febrile neutropenic oncology patient with persistent fever despite empirical antibacterial therapy is best treated with amphotericin B for possible Candida spp. sepsis. 

Bhattacharjee, A.K., Opal, S.M., Palardy, J.E., Drabick, J.J., Collins, H., Taylor, R., Cotton, A., Cross, A. Affinity-purified Escherichia coli J5 lipopolysaccharide-specific IgG protects neutropenic rats against gram negative bacterial sepsis. J Infect Dis 170 (1994) 622-629. 

Adverse effects. Molgramostim causes medullary bone pain, skin rashes, lethargy and myalgia in 10-20% of patients. It may also cause fever, the interpretation of which presents a clinical dilemma in neutropenic patients who are subject to sepsis. Pleural and pericardial effusions occur after high doses. 

Antimicrobial combination therapy is used frequently to treat serious infections. Combination therapy may be used prior to knowing the pathogen or antibiotic susceptibility for the treatment of infections in neutropenic patients and in patients with enterococcal endocarditis or bacteremia, sepsis, or pneumonia caused by P. aeruginosa. In these cases, it is important to know whether the combination will have beneficial (or detrimental) effects on the overall antibacterial activity of the regimen. For example, the combination may result in activity that is... 

The average duration of antimicrobial therapy in the normal host with sepsis is 10 to 14 days. " However, the duration may vary depending on the site of the infection, as well as the overall response to therapy. After the patient is stable hemodynamically, has been afebrile for 48 to 72 hours, has a normalizing white blood cell (WBC) count, and is able to take oral medications, then a step-down from parenteral to oral antibiotics can be considered for the remaining duration of therapy. Treatment may continue considerably longer if the infection is persistent. In a neutropenic patient, therapy usually is continued until the patient is no longer neutropenic and has been afebrile for at least 72 hours. 

Low-dose therapy (i.e., 150 mg/nP of body surface area of trimethoprim and 750 mg/nP of body surface area of sulfamethoxazole) is effective for the prophylaxis of infection by P. jiroveci. Significant protection against sepsis caused by gram-negative bacteria also was noted when 800 mg sulfamethoxazole and 160 mg trimethoprim were given twice daily to severely neutropenic patients. The emergence of resistant bacteria may limit the usefulness of trimethoprim— sulfamethoxazole for prophylaxis. 

Drusano, G. L. et ah. Pharmacodynamics of a fluoroquinolone antimicrobial agent in a neutropenic rat model of Pseudomonas sepsis, Antimicrob. Agents Chemother., 37(3) 483 90, 1993. 

In a separate set of neutropenic mice (n = 10/group), Klebsiella pneumoniae sepsis was induced. All control mice died, whereas 70% of mice given Tinospora cordifolia alone survived. There was a significant leucocytosis in the Tinospora cordifo-/f i-treated groups and a concomitant ablation in the cyclophosphamide-induced leucopenia that explained the protection [17]. 

A wide variety of infectious complications may develop after transplantation (Fig. 6.1.4). During the neutropenic period, fever appears in practically all patients. The causative pathogens are usually Gram positive cocci entering the body through the intravenous catheter or as a consequence of severe oral mucositis. Gram-negative sepsis may also oc-... 

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